Leslie R. Harrold, MD, of the University of Massachusetts, offers her thoughts about head-to-head studies of biologics in rheumatoid arthritis.

Our recent story "RA Treatment: When a Biologic Fails" discussed the current challenges associated with switching treatment after a patient fails on a first tumor necrosis factor (TNF) inhibitor. The article discussed two recent studies, both published online in the Annals of the Rheumatic Diseases, comparing outcomes when patients were given a second TNF inhibitor or a biologic of a different class after initial failure. In one study, SWITCH-RA, patients given rituximab rather than a second TNF inhibitor had significantly better results on disease activity scores after 6 months. However, in a study comparing abatacept with additional anti-TNF treatment, similar results were seen for both treatments.

Rheuminations asked the lead investigator of the abatacept trial, Leslie R. Harrold, MD, of the University of Massachusetts in Worcester, for her thoughts about the implications of these studies for clinicians today. Here is her response:

Clearly rheumatologists want to help their patients who are not responding adequately to TNF inhibitors. Switching mechanism of action seems a logical next therapeutic step for most clinicians. However, we need data to help identify whether it is a specific change that makes a difference or if any change will do.

This is why comparative effectiveness studies such as these are so important to practicing physicians. In our work, switching to abatacept was no better than to a subsequent TNF inhibitor. In contrast, in SWITCH-RA, rituximab was associated with better outcomes than a subsequent TNF. Of course, these two studies were different in terms of patient characteristics and enrollment criteria.

However, with all those caveats, these findings seem to suggest that any change in mechanism of action is not enough, but rather drugs targeting certain mechanisms of action will be more successful than others. Comparative effectiveness studies comparing the different non-TNF biologics are needed.

Rheuminations is a blog by staff writer Nancy Walsh for readers with an interest in rheumatology.

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